Provider Demographics
NPI:1508129651
Name:VILLAGE OPTICAL, CORP
Entity Type:Organization
Organization Name:VILLAGE OPTICAL, CORP
Other - Org Name:COHEN'S FASHION OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:GRINSHPUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-645-1395
Mailing Address - Street 1:5 GREENWICH AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10014-3543
Mailing Address - Country:US
Mailing Address - Phone:212-645-1395
Mailing Address - Fax:212-645-2710
Practice Address - Street 1:5 GREENWICH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10014-3543
Practice Address - Country:US
Practice Address - Phone:212-645-1395
Practice Address - Fax:212-645-2710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-22
Last Update Date:2012-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003908-1332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier